Bone-setting splint



Sept. l0; 1940. A AA THOMAS 2,214,490

BONE-SETTING SPLINT Filed Feb. s, 1937 s Sheets-sheet 1 E INVENTOR. ;IJ2 played @Ljmm l BY .zr l s www( Y Mn..

ATTORNEYS.

sept. 1o', 1940. A A THOMAS 2,214,490

Bours-SETTING SPLINT Filed F'eb. 8, '193' l 3 Sheets-Sheet 2 gwn-0J# ATTORNEYJ Sept. l0, 1940. A A, THOMAS 2,214,490

BONE-SETTING SPLINT Filed Feb. 8, 1937 3 Sheets-Sheet 3 INVENTOR.

BY Q4/prf .24.7200115263 ATTORNEYS.

and will appear in detail as the description proy Patented Sept. 10,1.940

Unirse srA'iss'v tPATENT OFFICE 18 Claims.

The present application relates to bone-setting splints, and moreparticularly is directed to improvements in splints of the generalcharacter disclosed in my prior Patent No. 2,056,749, issued October 6,1936. A primary object of the invention is to provide means whereby thestructure of splints of this general character'may be simplified andrendered more satisfactory for use in connection with a convalescingpatient. Further objects of the invention include improvements ofdetails of construction of such a splint;

ceeds.

To the accomplishment of the above and related objects, my invention maybe embodied in the form illustrated in the accompanying drawings,attention being called to the fact, however, that the drawings areillustrative only, and that any change may be made in the specicconstruction illustrated and described, and that the elements embodiedin my invention may be used in any number, position, or combination'thatis necessary to meet the indications for treatment in any specificindividual fracture, so long as the scope of the appended claims is notviolated.

Fig.' 1 is a side elevation of one form of my present invention;

Fig. 2 is a plan view thereof;

Fig. 3 is a perspective View of a bracket used in connection with thesplint of the present application;

Fig. 4 is a perspective view of a diierent type of bracket likewise usedin connection with the splint of` the present application, the elementsthereof being shown out of normal adjusted position for clarity ofillustration;

Fig. 5 is a perspective View of certain elements of the inventionarranged in a different manner;

Fig. 6 is a sectional view .through a supDOrt used in connectionwith theapparatus' of the present application;

Fig. '7 is a fragmentary plan of the support illustrated in Fig. 6,portions being broken away for clarity of illustration;

Fig. 8 is a section through a different type of support, likewise usedin the apparatus of the present application; I

Fig. 9 is' an elevation of an velement of the organization of Fig. 8;

Fig. 10 is an elevation of another element of the organizationillustrated in Fig. 8;

Fig. 11 is a longitudinal section through a still further type ofsupportor attaching means;

Fig. 12 is a plan view of another form of attaching means;

Fig. 13 vis a section therethrough taken substantially upon the lineI3-I3 of Fig. 12 and looking in the direction indicated by the Varrows;7

Fig. 14 is a side View of still another form of attaching means;

Fig. l5 is a transverse section taken substantially upon the line IE-IEof Fig. 14 and looking 10 -in the direction indicated by the arrows;

Fig. 16 is an end elevation of an adjusting mlechanism;

Fig. 17 is a side elevation thereof, looking from the left of Fig. 16;

Fig. 18 is a section taken substantially on the line IS--I of Fig. 17and looking in the direction indicated by the arrows;

Fig. 19 is a iragmental section, showing a portion of a bone and asupport for a threaded drill 20 engaging the same;

Fig. 20 is a section through the drill and support of Fig. 19 taken atright angles thereto;

Fig. 21 is an enlarged view of a detail of the organization of Figs. 19and 20; and

Fig. 22 is a somewhat enlarged view taken substantially on the line22-22 of Fig. 2 and looking in the direction of the arrows.

Referring more particularly to the drawings, and specifically to Figs. 1and 2, it will vbe seen that I have illustrated a splint comprising abase indicated generally by the reference numeral IU,

and consisting cI" end members II and telescopic side elementscomprising tubes I2 and rods or tubes I2 received therein andjprovidinga mounting for two elements I3 and I4 in which is mounted a threaded rodI5 which may be clamped in any desired position in the base. Screws I6are provided for tightly closing the clamping elements I3 and I4. 40

A split clamping sleeve I'I is mounted upon the rod I5 adjacent one endthereof, and provides a mounting for a support I3 which is illustratedspecifically in Figs. 6 and 7. As is clearly to be seen in thosefigures, the split sleeve I1 is pro- 45 vided with a clampingscrew I'Iand carries a rail I9 to which is suitably secured a ring member 26. Aring 2iA is received between the member 20 and a third ring'22 which isthreadedly received within a flange 23 of ahcusing element 24. 50Surrounding the ring 26 and spacing the same from the flange 23 is aninterrupted ring 25, a stud 26 carried by the vring 2| projectingthrough the interruption between theends of the ring 25, and through anaperture in the housing element medium of a bolt d4 and wing nut 44".

24 to receive a wing nut 21. This construction permits, when the nut 21isI loose, free and une limited rotation of the housing element 24 aboutits vertical center; but said housing may be held against such rotationby tightening the wing nut 21 to clamp the ring 25 between the ring 2iand housing element 24.

Suitably mounted upon the housing 24 is a guideway 28 in which isreceived a part-annular saddle 29 which is formed, in its outerperiphery, with a plurality of equally spaced sockets 35 with whichcooperate the teeth 'of a pinion 3i suitably carried by the guide 28,said pinion being actuable by a hand wheel 32. Preferably, means, suchas a clamping bolt 28', is provided for locking the saddle againstmovement through the guide 2&3;` but when that means is released, thesaddle may bek rotated about its center of curvature by operation of thehand wheel 32. At the extremity of each of the arms, the saddle 29 isprovided with means, indicated at 33 in Figs. 2 and 5, for iirmlygripping one end of a Wire or drill 34 (Fig. 2) which is adapted to beprojected through a fractured bone. The device is so proportion-ed andarranged that the wire 34, when in position, intersects the center ofcurvature of the saddle-29.

A second split sleeve clamping means 35 is suitably slidably mountedupon the rod l5, and is flanked by two nuts 36 and 31 whereby saidsleeve 35 may be shifted axially oi the rod` l5. Said sleeve 35 carriesa unit I8' identical in all respects with the unit I8, and whichsupports a saddle 29 identical in all respects with the saddle 25adapted to be adjusted by means of a hand wheel 32. Said saddle 29carries a wire 38 (Fig. 2) similar to the wire 34.

A bracket 39 is mounted upon one arm oi the saddle 29. This bracket isillustrated in detail in Fig. 4, from a consideration of Which it willbe seen that the bracket comprises a clamp i5 including walls 42 and 43with which cooperates a tongue 44, which is adjustable through the Thesocket formed by the walls i2 and i3 and the tongue 44 may be tted overan 'arm of the saddle 29, and clamped in place by operation of the nutdfi" and a set screw 4l carried by the wire or needle 34. A split sleeveclamping member 41 is mounted upon the trunnion 46 and is provided witha pair of ears 48 with which cooperates a clamping screw i9 which isoperable to clamp the sleeve 41 in any desired adjusted position on thetrunnion 46. The sleeve 41 carries a trunnion 55 which is perpendicularto the axis of the sleeve 41, and upon which is mounted a split sleeve iprovided with spaced ears 52 with which cooperates a clamping bolt 53.The sleeve 5I carries a. further split sleeve 5t, perpendicular to theaxis of the sleeve 5i, and provided with spaced ears 55 with which isassociated a clamp- -ing bolt 56. A rod 51 is received in the sleeve 54.

It will be seen that this arrangement provides a mounting for the rod 51which will permit oscillation of said rod about its own axis and abouttwo external, relatively perpendicular axes. The mounting is soconstructed, however, that oscillation about any one of theabove-mentioned axes may be prevented, the means for preventingoscillation about the respective axes being respectively independent.

As will be seen from an inspection of Fig.

the bracket 39 is mounted adjacent one extremity of the saddle 29, and asimilar bracket 59a is mo-unted adjacent the opposite extremity of saidsaddle. The rod 51, carried by the bracket 39, carries at its oppositeend a similar bracket 39h which is secured adjacent one lextremity of asaddle 58. The rod 51a carried by the bracket 35a carries likewise abracket 39o which is secured ,to the opposite extremity of the saddle58. By this means, the saddle 58 is connected to, and supported from,the saddle 29; and it will be seen that, if the clamping bolts 55 and 53of the brackets 39 and 39a are tightened; and if all of the clampingbolts of the brackets 3th and are tightened, the saddle 58, with itsassociated wire 59, may be moved with respect to the saddle 29 onlyabout the axis of the trunnions d6 of the brackets 39 and 39a, which iscoincident with the axis of the wire 34. Thus, the saddles 29 and58,*vvith their associated wires 34 and 59, have been converted into asingle unit, the parts of which may berelatively adjusted in one manneronly.

Brackets 35d and 39e are associated with the saddle 29', and their rods51h and 51C support brackets 3W and 39g which are secured to the arms ofa saddle 6U with which is associated a wire 6i. In a like manner, thesaddles 25 and 55 are thus arranged for unitary manipulation. When thetwo units, comprising the four saddles, have been suitably adjusted,they may be locked in such adjusted position through the medium oi themechanism now to be described. It is to be noted that the trunnion 45 ofeach of the brackets (39, 39a., 39h, 39o, 39d, 39e, 3M and 39g) iscoaxially aligned with the wire (34, 3d, 55 or 5l) with which it isdirectly associated.

In Fig. 3 there is illustrated a bracket indicated generally by thereference numeral 62. Said bracket is formed, like the clamp 45, toprovide a wall 53 bounded by parallel walls S4 and 66. A tongue S5 isassociated with the wall 64 and is shiftable through the medium of abolt 65 and a wing nut 65, and a set screw 61 is carried by the wall 65.The wall 66 may be hooked over a portion or the saddle 58 so that,when-the set screw 61 is turned down and the wing nut 55" is suitablyoperated, the saddle portion will be tightly gripped whereby the bracket52 is rigidly associated with said saddle.

Depending below the Wall 64 are a pair of spaced legs 58 and 55 formedwith aligned apertures. In Fig. 3, the aperture 1d in the leg 58 isclearly shown, but the perspective of the gure is such as to prevent aView of the aperture in the leg 59. A ball 1l is received between thelegs 8 and 59 and projects part Way through the apertures in the legsE58 and 69. Said ball is formed with a polar bore in which is received arod 12 adapted to be secur-ed in adjusted position by a set screw 13received in a threaded bore intersecting the bore in which is receivedthe rod 12. A clamping bolt 'P4 is associated with the extremities ofthe legs B8 and 69 and is provided with a hand bar 15 whereby s-aid boltmay be rotated to clamp the legs 58 and B9 against the ball 1l toprevent movement thereof.

A similar unit 52a is connected to the saddle 53 at a spaced point; andthe rods 12 and 12a are connected also to the balls 1| of' brackets 62hand 62o carried by the saddle 60.

It will be obvious that, when the clamping bolts 49, 53, and 56, of theVbrackets 39, 39a, 39h, 39o, 39d,v 39e, 39j, and 39g, and the clampingment with respect to each other.

boltsvlll and set-screws 13 of the brackets 62, 62a, 6 2b, and 62e areall tightly set, the four saddles 29, 29', 58 and 80 arerigidly heldagainst move- Preferably, the .rod |5 is formed with alongitudinallyextending slot ,or kerf |38 (see Figs. 2 and 5) and the sleeves |1 and35 are provided withnkeys lreceived in said slot. to hold said sleevespositivelyagainst rotationabout the axis ofthe rod i5. v u y In Fig.A 5thereis illustrated a somewhat more complicated embodiment of thepresent invention which is useful where extremely close adjustments arenecessary. l p

In said embodimentof the invention, I have shown a sleeve in place ofthe sleeve 35, said sleeveV 80 being formed with a perpendicularstandardv 8i receiving a threaded rod 82 upon which is slidably mounteda split clamping sleeve 93 flankedV by'nuts 84,only the upper one ofwhich isshown. Said sleeve 83 carries a supporting unit whichisillustrated in detail in Figs. 8,79 and 10.

Said unit comprises a disc 88 having a peripheral, externally threadedange 81 with which is -threadedly associated a flanged sleeve88`supporting a ring 89. Between the ring 89 and the disc 88 is receiveda disc 90 to which is suitably secured, as b y screws 9|, an element 92.The disc isprovided with a depending tongue 93 for a purpose later to beexplained.

The element 52 Vis formed with a bore 94 in which is received a coiledspring and a ball 96, the end of the bore 90 being peened over to holdtheV ball 95 within the,y bore.

' A backrv plate 91 is suitably secured to one surface of the element 92and provides a bearing for one end of a shaft 98 upon which is mounted apinion 99 received in a socket |00 of an element i0| secured to the backplate 91. As is clearly shown in Fig. 9, the elements 92 and |0| areformed to provide curved walls |03 and |04 cooperating with the wall 91to form a guide for a saddle |95. Said saddle is formed on its innersurface with rack teeth adapted to cooperate with the pinion 99; and itwill be clear that the ,elements 92, 91, and lill form an open-sidedguide into which the saddle may be inserted through the open side. Y

A front plate |08 is formed with one curved edge 01 adapted to bereceived in a groove |08 formed in the surface |04 of the element |0|.As is clearly shown in Fig. 8, the lateral extent of the element 92 issubstantially equal to the thickness of the saddle |05; while thelateral extent of the element -|0| is somewhat greater. The inner wallof the groove |08 lies substantially in the plane of the forwardlypresented face of the element 92.

The edge of the closure plate |06 opposite the edge i0? is formed with aprojecting tongue |09 which is adapted to be inserted in the spacebetween the forward face of theelement 92 and the depending tongue '98on the disc 90, thereby engaging the ball 95 to be pressed, by thespring 95, against thetongue 93. After insertion of the tongue E09 intothe space between the element 912 and the tongue 93,' the edge |01 ofthe plate E95 may be shifted into registry with the groove |08,whereafter the plate |08 may bev moved downwardly to enter the edge |01iinto the groove |08. The tongue |09 is of such length that, even afterthe edge |01 of said plate has been seated in the groove |88, the tongue|09 is still engaged by the ball 98. Theedge v|01 ofthe plate |05 isnotched as at ||0 for cooperation with a portionnl of the element |0|which interrupts the groove |08.

On its inner face, the plate |05 is provided with retainers |2 and I3which hold in place a leaf spring I|4 adapted to engage and press lagainst the outer face of the saddle |05; and set screws ||5 and ||6.are provided to force said spring ||4 into clamping engagement withsaid saddle.

It will be clear that'rotation of the shaft 98 through the medium of thewing |02 will cause adjustment of the saddle |05 about its center ofcurvature; that the saddle guide may be rotated about the center of thedisc 86; and that the sleeve 83 may be vertically adjusted on rod 82 bymanipulation of the nuts 84, and may be manually rotated about the axisof the rod 82 unless locked in place by tightening the clamping bolt83.. A set screw 85 is preferably provided to lock the disc 90 againstrotation, when desired. The saddle |05 is provided with means forgripping the ends of a wire ||1 which is located in such a position assubstantially to intersect the center of curvature of the saddle |05.

Similar units 85a and 85h are mounted upon threaded rods ||8 and H9which are horizontally supported in a manner now to be described. Sincethe units in which are included rods ||8 and ||9 are identical in allrespects, only one will be described.

The rod I|9 is carried by a sleeve |20 which is flanked by nuts |2| and|22 and adjustably mounted on a threaded rod |23. The rod |23 is carriedby a split clamping sleeve |24 mounted upon a rod |25 carried by a clampunit |28. The unit |28 is illustrated in detail in Fig. ll.

The rod |25 is received in a sleeve |21 carried by a part-cylindricalelement |28 to which is hinged a part-cylindrical element |29 having adepending ear H30 which is notched as at |3|. The element |28 likewisecarries a hinged ear |32 in which is threadedly received a bolt |33formed with a shoulder |30. Obviously, if the bolt |33 is loosened, bycounterclockwise rotation of the hand bar |35, the bolt may be droppedout of the notch |3| by hinging movement of the ear |32. Thereafter, theelement H29 may be swung away from the element |28 and the unit may belifted off the rod l5. In a suitable slot |36 formed in the element |28is slidably received a key |31 adapted to enter the slot |38 in the rodi5. Said key 31 is formed in one facey with two sockets |39 and |40adapted alternatively to receive a ball lill urged outwardly from a bore|42 formed in the element |28 by a spring |43 received therein. In theposition illustrated in Fig. 11, the key 31 will hold the unit |29against rotation about the axis of the rod I5; but such key may bewithdrawn to permit such rotation. Upon such withdrawal, the ball Mlwill hold the key in withdrawn position until it is again manuallydepressed.

The organization of Fig. 5 will be used in cases in which extremely neand delicate manipulation oi the bone fragments is necessary. Ifdesired, after the bone fragments have been suitably positioned by suchdelicate manipulation, brackets 39 and rods 51 may be associated withthe saddles 29, |05, |05a and |051)` in the manner illustrated in Figs.l and 2, and thereafter the saddles I05a and |051) may be removed fromtheir holding units 85a and 85h and the clamping units |26, togetherwith all of the elements carried thereby, may be entirely removed fromthe organization.

If desired, one end of the sleeve |26 may be provided with crown teeth|95, and an element |46 may be associated therewith. The element |48 ismounted upon the rod l5 and is provided with crown teeth |81 forcooperation with the teeth of the sleeve |26. A key |48, carried by theelement |46, is projectible into the kerf |38 to hold the element |86against rotation about the axis of the rod |5. Obviously, if the key |31is retracted, and if the key |48 is projected into the kerf |35, thesleeve |26 may be adjusted about the axis of the rod 15, to any one of aplurality of positions, depending solely upon the number of teeth E45and |51 provided on the elements |26- and |88.

If desired, I may mount upon the rod l5 a split sleeve supportingelement |49 directly carrying a unit 85e similar to the unit 85. In theguideway of said unit 85o, there may be mounted a saddle |49 with whichmay be associated a unit 39h. Preferably, the end of the saddle |49 iscylindrical, so that the clamp member of the unit 39h may be adjustedabout the axis of the end of said saddle. In the tube or sleeve 54h ofthe unit 39h there is clamped a tube |50 provided with a set screw 15|,said tube receiving a drill |52 which is adapted to be driven into abone or bone fragment, without projecting entirely through said bone. Itwill be seen that the illustrated arrangement provides for a widevariety of adjustments of the drill |52.

In Figs. 12 and 13, I have illustrated an attaching unit |53 which maybe substituted, if

desired, for the unit Bti-6|, for the unit |20, for the unit |24, or forthe unit |25. The unit |53 comprises a part cylindrical element |54 towhich is hinged a second part cylindrical |55, said elements beingadapted to be clamped about the associated rod l5 through the medium ofa bolt |56 similar to the bolt |33 or the bolt |1| or the bolt |15, andsimilarly associated with the elements |55 and |55. At one end, the tubeformed by the elements |56 and |55 is formed with a worm wheel |51.

Laterally projecting from the element |54 and perpendicunlar to the axisof the tube formed by the elements |55 and |55, is a socketed tube |58,the free end of which is likewise formed to provide a worm wheel |59. .Aset screw |60 is provided for engaging an element received in the socketof the tube |58; said element so received being preferably provided withan annular groove for the reception of the set screw end, whereby saidelement may be rotated about its own axis without axial movement.

A guideway |6|, likewise preferably integral with the element |54,receives a key |62 adapted to be projected into the interior of thesleeve 01 tube formed by the elements |54 and |55 to enter the kerf |38in the rod |59. Said key is formed with a gripping head |63 outside theguideway |6|; and Within the guideway |6I, said key is notched as at|64. A screw |65 projecting into the guideway |6| enters the notch |64to limit the throw of the key |62.

The key |62 is likewise notched in its opposite edge as at |66 toreceive a spring |61 and a ball |68, said spring urging the balloutwardly of the notch |66. 'Ihe adjacent Wall of the guideway |6| isformed with two or more sockets |69 and |10 adapted to receive a portionof the ball |60 to hold the key |62 resiliently in either of twoadjusted positions. A suitable clamping bolt |1| other means,'mountableon the rod |5, or on any other one of the supporting rods, forsupporting units which are desired to be used in adjusting or holdingthe bone fragments. Said unit comprises a pari; cylindrical element |12to which is hinged a part cylindrical element |13.

The element |12 is formed with a notched ear in which is oscillablymounted the head |14 of a bolt |15. The unit |13 is provided with an earslotted as at |16 for the reception of the bolt shank |15, the end |11of a socket nut |18 being receivable against the outer surface of theslotted ear of the element |13. Obviously, when the hand-bar |19 isrotated in a clockwise direction, the elements |12 and |13 will beforced toward each other.

The element |12 is formed with a socket |80 in which are received aspring |8| and a ball |82, the spring urging the ball toward a seat inone o-r the other of twosockets |83 and |84 formed in a key |85 slidablymounted in a slot formed in the element |12. The key |85 is formed witha notch |86 with which cooperates a screw |81 to limit the movement ofsaid key.

The element |12 likewise carries a disc |88 formed with a threaded bore|89 for the reception of a bolt |90 which carries a second disc |9I. Asuitably formed arm or bar may be mounted upon the unit of Figs. 14 and15 by removing the bolt |90y passing it through a bore formed in saidarm or rod, and then threading the bolt |90 again into the bore |89 andturning it up to clamp said rod or bar between the discs |9| and |88.Obviously, with this arrangement, the mounted armor bar may be moved toany one of a plurality of adjusted positions about the axis of the bolt|90, and may be clamped in any one of such positions.

In Figs. 16, 17 and 18, I have illustrated mechanism associable with theunit |53, for mechanically moving said unit into any desired position ofadjustment about the axis of the rod on which said unit |53 is mounted,and for holding said unit in any such position. The unit of Figs. 16,1'1 and ,18 comprises a part cylindrical element |9| to which is hingeda part cylindrical element |92. The element |9| is formed with aprojection |93 in which is carried, in a manner similar to thatillustrated in Fig. 15, the head of a bolt |94. The element |92 isformed with a slotted ear |95 for' the reception of the stem of the bolt|94;

said bolt carrying associated nut |96 provided.

with a hand bar |91.

A key |98, having a thumb piece |99, is adjustably mounted in a slotformed in the element |91, and is adapted to be projected into the kerf|38.

The element |9| carries a standard 200 which, at its free end, isbifurcated to provide opposed journals for a trunnion 20| in which isrotatably mounted a tubular shaft 202 carrying a worm 203. Fixed on theshaft 202 is a hand-Wheel 204; and an axle 205 provides a journalmounting for the shaft` 202, said axle having one end received in asocket 201 formed in a standard 208 carried by the element |9|. A thumbpiece 206 is fixed on the axle 205.

ivo

It will be obvious that the unit of Figs. 16, 1'7, and 18 may be mountedupon the rod l5 and lclamped in position thereon by the action of thenut S3, the key |98 being projected into the kerf |38. 'Ihe unit may beso positioned as to engage the worm 203 with the teeth of the wormwheel51. Now, if the key |62 is retracted, rotation of the hand-wheel 204will result in adjustment of the unit |53 about the axis of the rod |5.If it is desired to make a gross adjustment of the unit |53, the axle205 may be withdrawn from its engagement in the socket 201, whereuponthe worm 203 may be shifted upwardly (rotating about the axis of thetrunnion 20|) out of engagemeni; with the teeth of the worm-wheel |51,

whereupon the unit |53 may be adjusted manually to any desired degree;after which the worm 203 may be again engaged with the wormwheel |51,the axle 205 again entered in the socket 201, and the ultimateadjustments may be made by rotation of a hand-wheel 204.

Alternatively, the unit of Figs. 12 and 13 may be substituted for theunit Sil- 8| and secured against rotation with respect to the rod l byengagement of the key |62 in the kerf |38. The rod 02 will then bereceived in the tube or sleeve |58; and said rod will preferably beprovided with n ing with the worm wheel |59, it will be obvious thatmanipulation of the hand wheel 204 will result in rotation of the rod 82about its own axls.

Similarly, the unit of Figs. 12 and 13 might be substituted for the unit|24, in which case, the unit of Figs. 16-18 could be used to rotate therod |23 about the axis of the rod |25. Or the unit |53 might besubstituted for ythe unit |20 in which case the unit of Figs. 16-l8could be used to rotate the rod ||9 about the axis of the rod 23. Thelatter effect might also be attained by substituting the unit of Figs.12 and 13 for the unit |24 and interposing the unit of Figs. 16-18between the sleeve |58 and the unit |20.

While the manner of use of the organizations of the present applicationwill be obvious to any skilled surgeon, it is believed that somediscussion thereof will be advantageous.

While the segments of the fractured limb above and below the fractureare maintained in as nearly as possible normal relationship to eachother and the trunk, the bone segments are en.- gaged by drills, as fardistal and as far proximal, and as near above and as near below the siteof fracture, as practicable. These drills may be driven entirely throughthe bone and the soft parts until their ends project on either side ofthe limb; or they may be driven only through' the soft parts on one sideof the limb and into the bone until firmly engaged therein, withoutpassing entirely through the limb. If the latter type of drill is used,the drill will be provided with self-tapping threads which willcooperate with threads out by the drill in the bone to fix the drillrmly in the bone. If the former type of drill is used, the drill will besmooth except at its point, so that, in the absence of provisionthereagainst, it will be possible for the bone not only to rotate aboutthe drill but also to shift longitudinally with respect tothe drill. Thebone may be held .against such longitudinal shifting either byl clampinga disc on the drill on either side of the limb in contact with the softparts, or, preferably, by forcing close-fitting metal tubes or sleevesof suitable length, and of a diameter slightly greater than the diameterof hole in the bone, over the protruding ends of the drill and intoContact with the rm outer cortical layer of the bone, and xing saidsleeves to the drill by suitable clamps. Alternatively, the bone may bexed with respect to the drill by clamping to each projecting end of thedrill an element supporting and guiding a spike which is forced throughthe soft parts and into Contact with the bone.

In the illustrated embodiments of my invention, the drills 34, 38, 59,6|, and, ||1 are of the first-mentioned type, while the drill |52 is ofthe second-mentioned type.

After the drills of the first-mentioned type have been` passed throughthe limbl in the manner above described, each drill is clamped to thearms of a saddle of the type illustrated.

Over each drill of the second-mentioned type (see drill |52 of Fig. 5)there is sleeved a tubular element of the type illustrated at |50 havinga lock bolt and nut, a set screw ||5|, or some other suitable means forclamping it immovably to the drill when adjustment is completed; andthat tube is then associated with the split sleeve 55h of a bracket unit39h mounted upon an element of the type illustrated at |49'. j

Alternatively, drills of the type of drill |52 may be supported in thelmanner illustrated in Figs. 19, 20, and 21. The reference numeral 2|0indicates an end of either a saddle or an element like the element |49;and it is preferably cylindrical at its upper end as at 2| saidcylindrical portion being formed with a peripheral groove 2|2.

A split clamping sleeve 2|3 is mounted upon said cylindrical portion 2||and is provided with a set screw 2|4 adapted to be received in thegroove 2 l2. A clamping bolt 2|5 is provided for locking the sleeve indesired position.

At its upper end, the sleeve is provided with separated discs 2|S and2|1, a clamping bolt 2|8 being provided to draw the said discs 2|6 and2|1 together. Said bolt, in use, passes through a disc 2|9 receivedbetween the discs 2|6 and 2|1, and carrying a split sleeve 220 in whichis received the drill |52. A clamping bolt 22| is provided for lockingthe drill in adjusted position in the sleeve 220.

In order to guard against possible axial move- A ment of the drill |52in the sleeve 22|), I may provide a pair of stop collars 222 which areillustrated in detail in Fig. 21. Each of said collars is formed with anon-'radial slot 223 opening into a central bore 224,'whereby the collarmay be slipped into place on the drill |52, the drill slipping from theslot 223 into the bore 224, and being adapted to be held thereinl bymeans lof a set screw 225.

Alternatively, the sleeve 2|3imight be mountist drills are associatedwith the frame-Work of the structure illustrated herein.

If We assume that We are working With an organization of the generaltype illustrated in Fig. 1, and if We assume that the `drills 84, 59,8l, and 38 have been passed through the limb With the drill 34 nearestto the trunk and the drill 38 farthest from the trunk, the saddles it*and 29 Will now be attached to the drills 3d and '.58 either before orafter they are mounted in the guide- Wa-ys of units I8 and t8. Dependingupon the requirements of the case, these units may be mounted eitherupon theA rod l5 or upon one of the other types of threaded rodsdisclosed in the drawings. The unit IS is now clamped to the rod I5 toprevent any shifting thereof during further adjustment of the bonefragments, and the saddle 29 is rotated, for instance by adjustment ofthe hand-wheel 32 associated therewith, until the axial position of theproximal segment of the limb is satisfactory; and the saddle is thenlocked and retained in this adjusted position. Of course, depending onthe type of mounting for the sa-ddle used, this rotation of the saddlemay be either manual or through the medium of a pinion or a Worm. Thoselocking devices which prevent rotation of the proximal fragment aboutits own axis being tightened, and the remaining locking devices of theorganization being loose, gross axial, longitudinal and lateraldisplacement of thge fragmentsA are either individually andsuccessively, or in combination and synchronously corrected; and as eachindividual displacement is apparently corrected, the locking devices aretightened as necessary to prevent its recurrence, until nally alldisplacements have been apparently corrected. The locking devices arethereafter undisturbed except to permit further adjustment of the mainfragments When the necessity therefor is indicated -by clinical or Y-rayexamination, puncture exploration or operative exposure of the fracturedbone ends.

During this adjustment, When it appears that rotation of the distalsegment on its long axis is necessary to correct axial displacement,this may be accomplished, in the iorganization of Fig. 1, by rotatingthe saddle 28' about its center of curvature, either manually ormechanically; or, in the organization of Fig. 5, it may be accomplishedby rotatingthe saddle 85 about the axis of the disc 8d of the unit 8:?,either manually or mechanically. After such gross adjustment, theadjusted saddle is locked in position.

When shifting of the distal supporting element is indicated to correctoverriding or longitudinal separation of the fractured ends of the mainbone fragments or to separate the. bone ends enough longitudinally topermit lateral movement of their more or less jagged surfaces over eachother during correction of lateral displacement, this is accomplished bythe adjustment of the nuts 36 and 3l in such a manner as to shift thedrill 38 of Fig. 1 or Il'I of Fig. 5 in the desired direction.

When lateral shifting of the fractured bone ends is indicated to bringthe main fragments into alignment and to bring their fractured surfacesinto proper relationship with each other, an eifort is made toaccomplish this first by manual movement of the bone ends for what seemsto be the proper distance in the proper direction. These apparentlysimple movements result from a more or less complex combination ofmovements as follows:

rIfhe bone segments may be rotated about the axes of the drills 34 and38 to shift their adjacent ends generally up and down; and the bonesegments may be rotated about vertical axes to shift their adjacent endsgenerally in a horizontal plane. Inl either the organization of Fig. 1or that of Fig. 5, the former type of movement is accomplished manually.In the organization of Fig. 1, the latter type of movement is effectedby adjustment of the saddle 2Q and 2Q about the centers of the housings24; which adjustment may be accomplished either manually ormechanically. In the organization of Fig. 5, the latter type ofadjustment may b-e accomplished by shifting the saddle H35 either aboutthe axis of the post 82, or about its own center of curvature, either ofwhich types of adjustment may be effected either manually ormechanically. When these various types of adjustnfientsV have beeneffected 'to bring the bone ends substantially into proper coaptation,the various means for locking the saddles 2@ and 2S (or E85) a-retightened.

Evenafter such locking of the terminal drills, xation of the mainsegments is not complete, since there is nothing lto prevent gravity andmuscle pull from rotating the bone segments about the drillsas axes, todisplace the adjacent endsv laterally at right angles to the drills. Toprevent this, and to complete iixation of the fragments Whilepermitting. adjustment thereof as indicated, saddles are attached to theintermediate drills, and those saddles are associated, either before orafter attachment to the drills, with suitable supporting units mountedupon the rod I5 either directly or through the intermediation ofseparate carrying nuts.

Referring, again, to Fig. 1,Y the saddles 58 and Si) are attached to thedrills 59 and 5I which have previously been driven through the limbadjacent the point of fracture. Either before or after attachment ofsaddles 58 and 5I to the said drills, the units 39 and 39a are connectedto the saddle 29, and the units 39d and 39e are attached to the saddle2S. Because of the universal adjustability of the units 89a, 39h, 38o,39d, 38e, 39f, and 39g, it is possible noW, the various clamping boltsbeing loosened, to connect the units 39h and 39C tof the saddle 58 andto connect the units 391c and 39g to the saddle Bil, the units attachedto the saddles 58 and 6i) being connected to the units attached to thesaddles 29 and 29' by the rods 51, 51a, 5'Ib and 51e. If, now, all ofthe clamping bolts of the various 39 units are tightened, it will bereadily apparent that the tWosegments of the fractured bone Aare heldagainst any possible movement. l

Clinical cr X-ray examination, puncture exploration or operativeexposure of the bone ends Will now be resorted to to determine Whetheror not the fractured ends are in accurate and satisfactory apposition.If it is found that they are not, efforts are made (after loosening theclamping nuts 49 of the units 39, 39a, 39d, and 39e and the clampingelement 26 of units I8 and I8') to bring the bone ends into suchaccurate apposition by manual manipulation to effect verticalcorrection, by adjustment of the saddles about their centers ofcurvature to effect axial correction, and by adjustment of the platforms24 of units I8 and I8', to effect horizontal correction, to bring thesegments into proper apposition. `If these efforts are successful andthe bone fragments are brought into satisfactory alignment and theirfractured surfaces into close and satisfactory apposition, all lockingdevices are tightened and the fragments are retained in this positioneither until they are firmly united or until reaction of the limb toinjury or infection has subsided or the Wounds healed sumciently topermit application of a plaster cast incorporating the drills to holdthe bone fragments in the same relative position, after which the limbis removed from the frame and the pa tient becomes ambulatory unlessotherwise contraindicated. Alternatively, in some instances, it ispossible to apply brackets 62 and 62a to the saddle 58, to applybrackets B2bz and 62o to the saddle 60, to connect those brackets byrods T2 and 12a, and to lock the rods in position. Thereafter, the bonefragments may be retained in proper rigid relation to each other solelythrough the medium of the four saddles and their connecting units, thesaddles 29 and 29 being removed from their supporting units I8 and I8'.Such an arrangement is, of course, highly advantageous, Since it givesthe patient materially increased freedom and is therefore conducive toadded comfort.

If lateral adjustment of fractured bone ends cannot be made manuallywith suffi-cient precision and accuracy, the saddles 58 and 60 aremounted, for instance in the manner of saddles Illb and Ill5a of Fig. 5.By shifting the sleeve of each supporting element a or 85h, and byshifting the supporting rods II8 and I I9, the fractured bone ends maybe mechanically shifted with precision and accuracy any distance in anydirection indicated, until physical and X-rayexaminations, exploratorypunctures', or operative exposure of the bone ends shows satisfactoryalignment and apposition of the main bone fragments. After vsuchsatisfactory alignment and apposition has been effected, the limb may beretained in an organization of the character of Fig. 5. or theintermediate saddles may be connected to the terminal saddles in themanner illustrated in Fig. 1, the bone fragments being thus held eitheruntil repair is completed or until a cast is applied in the manner abovedescribed.

Drills of the type of the drill I52 in Fig. 5 may be used in place ofdrills of the type of the drill 34, but I prefer to use drills of thetype of drill |52 only for the purpose of locating and fixing detachedbone fragments.

While I have illustrated certain arrangements of the elements of thepresent invention, it is to be understood that there is a substantiallyi1- limitable possibility of variations in those arrangements. Forexample, any o-f the rods used in the invention may be either plain orthreaded, may be with or Without one or more kerfs, may or may not beprovided with circular grooves adjacent its ends for cooperation withset screws in supporting sockets to permit rotation of the rod, and mayor may not be provided with a terminal element receivable between a pairof clamping discs to be mounted upon the clamping bolt. Any of thesaddley support units may or may not be constructed to permit adjustmentof the saddle or the supporting platform man ually, by a spur-gear, by acrown-gear, or by a worm-gear; the support may or may not provide forremoval of the saddle therefrom without disturbing the drill held by thesaddle.

The various sleeves of the present invention may be either closed tubesor split tubes., and may or may not be hinged tubes. Similarly, thevarious sleeves may or may not be provided with a key which may be fixedor shiftable.

'Depending upon the required uses of the sleeves,

they may or may not be provided with set screws for cooperation withannular grooves in associated rods; and such sleeves. may or may not beassociated with shifting nuts at one or both vends thereof. In the sameway, such sleeves may or may not be provided with worm-wheels at one orboth ends thereof for cooperation with a unit `of the type illustratedin Figs. 16, 17 and 18.

The unit of Figs. 16, 17 and 18 may be provided with a closed tube forassociation with the supporting rod, with a split tube, or with a hingedtube. It may or may not be provided with a key which may or may not beshiftable; and it may or may not be so constructed that the worm lmaybereadily shifted out of normal position to permit gross adjustment of theelement normally operated by the worm.

' l It is to be understood that the exigencies of the particular casewhich confronts a surgeon will determine the manner in which the surgeonwill combine the various units of the present organization to provide asatisfactory structure to perform the operation which appears to benecessary; and that only the skill of the surgeon Vwho is operating candetermine the proper steps crowded, the unit which carries the rod II8may be differently mounted as follows: Upon the rod |25, in place of theunit I2lI, may b'e mounted a similar unit carrying a threaded rod, saidrod projecting horizontally toward the end of the frame carrying themounting I 4. Upon that horizontally projecting rod may then be mountedthe unit |24, carrying the rod I23 and the rod II9; and that samehorizontally projecting rod may likewise carry the correspondingelements whereby the rod IIB is supported.

I claim as my invention:

1. In a device of the class described, a base, a saddle carried by saidbase and provided with means adjacent the extremities of its two armsfor gripping a wire adapted to be projected l,through a bone, a bracketsecured to each of said arms vand comprising a gripping element movableabout two perpendicular axes, independent means operable to preventmovement of said gripping element about either of said axes, a rodreceived in each of said gripping elements, a second saddle providedwith means adjacent the extremities of' its two arms for gripping asecond wire adapted to be projected through a bone, a bracket secured toeach of the arms of said second saddle and comprising a gripping elementmovable about two" perpendicular axes, and independent vmeans operableto prevent movement of each of said last-mentioned gripping elementsabout Ieither o-f its associated axes, said rods being received also insaid last-mentioned gripping elements.

2. In a device of the class described, a bonemanipulating unitcomprising a saddle adapted kto be adjustably mounted on a base, asecond saddle, two members adapted to be driven through a bone at spacedpoints, means on said respective saddles for gripping the o-ppositeprojecting ends of said respective members, and means providing amanipulable connection between said saddles, said last-named meanscomprising two rods extending between the arms of one of said saddlesand the corresponding arms of the other of said saddles, and meansconnecting said rods to said arms and permitting, at times,substantially universal movement of said Second saddle with respect tosaid rst saddle but preventing, at other times, any movement of saidsecond saddle other than oscillation thereof substantially about theaxis of the bonepenetrating member associated with the irst saddle.

3. In a device of the class described, a unit comprising a saddlemounted on a base, two brackets secured to said saddle adjacent theopposite ends thereof, each bracket comprising a trunnion locatedsubstantially in the plane of said saddle, a clamping sleeve mounted onsaid trunnion and carrying a second trunnion substantially perpendicularto said sleeve, a second clamping sleeve mounted on said second trunnionand carrying a third clamping sleeve substantially perpendicular to saidsecond sleeve, means for independently tightening or loosening saidrespective clamping sleeves, a rod carried in the third clamping sleeveof each bracket, bone-engaging means carried by said saddle, andbone-engaging means associated with and supported and positoned by saidrods.

4. In a device of the class described, a unit comprising a saddlemounted on a base, two brackets secured to said saddle adjacent theopposite ends thereof, each bracket comprising a cylindrical elementlocated substantially in the plane of said saddle, a second cylindricalelement supported by said iirst cylindrical element for oscillationabout a common axis, a third cylindricalv element rigidly associatedwith said second cylindrical element, a fourth cylindrical elementsupported by said third cylindrical element for oscillation about acommon axis, a fth 4cylindrical element rigidly associated with saidvfourth cylindrical element, a support carried by the fth cylindricalelement of each bracket, and independent means operable to preventoscillation of said second and fourth cylindrical elements and toprevent movement of said support relative to the fifth cylindricalelement of each bracket.

5. In a device of the class described, a base, two standards carried bysaid base for adjustment toward and away from each other, a first saddlecarried by one of said standards, a second saddle carried by the otherof said standards, a third saddle, means carried by said rst saddle forpositioning said third saddle, a fourth saddle, means carried by saidsecond saddle for positioning said fourth saddle, bone-engaging meansrigidly connected to each of said saddles, and means connecting saidthird and fourth saddles and cooperating with said positioning means tolock said irst, second, third, and fourth saddles into a rigid unit.

6. In a device of the class describeda base, two standards carried bysaid base for adjustment toward and away from each other, a first saddlecarried by one of said standards, a second saddle carried by the otherof said standards, means carried by said standards for adjusting saidsaddles with respect to said standards and to each other, a thirdsaddle, means carried by said first saddle for positioning said thirdsaddle, a fourth saddle, means carired by said second saddle orpositioning said fourth saddle, whereby said rst and third saddlesconstitute a unit adjustable by said adjusting means and said second andfourth saddles constitute a unit adjustable by said adjusting means,bone-engaging means rigidly connected to each of said saddles, and meansconnecting said third and fourth saddles and cooperating with saidpositioning means to lock said rst, second, third, and fourth saddlesinto a rigid unit.

7. A unit for use in a device or" the ciass described, comprising aclamp, a trunnion projecting from said clamp, a clamping sleeve mountedon said trunnion and carrying a second trunnion substantiallyperpendicular to said sleeve, a second clamping sleeve mounted on saidsecond trunnion and carrying a third clamping sleeve substantiallyperpendicular to said second clamping sleeve, and independent means fortightening said respective clamping sleeves.

8. A unit for use in a device of the ciass described, comprising aclamp, a pair of spaced legs carried by said clamp and formed withaligned perforations, a substantially spherical element having a polarbore therethrough received between said legs and partially penetratingsaid pericrations, a rod mounted in said bore, means carried by saidelement for holding said rod against movement in said bore, and meansfor urging said legs toward each other.

9. A holder for a curved saddle comprising a curved guide having an openside, one curved wall of said guide being formed with a groove, and aremovable closure plate, having one edge receivable in said groove, toclose the open side of said guide.

10. A holder for a curved saddle comprising a curved guide having anopen side through which a saddle may be received, one curved wall ofsaid guide being of a lateral extent substantially equal to thethickness of said saddle and the other being of greater lateral extentand being formed with a groove in its inner surface, and a removableclosure plate having one edge receivable in said groove.

11. A holder for a curved saddle comprising a curved guide having anopen sidethrough which a saddle may be received, one curved wall of saidguide being of a lateral extent substantially equal to the thickness ofsaid saddle and the other being of greater lateral extent and beingformed with a groove in its inner surace, one Wall of said groove beinglocated substantially in the plane of the lateral edge or said onecurved wall, and a removable closure plate having one edge receivable insaid groove and having its opposite edge held in contact with saidlateral edge.

12. A holder for a curved saddle comprising a curved guide having anopen side through which a saddle may be received, one curved wall ofsaid guide being of a lateral extent substantially equal to thethickness of said saddle and the other being of greater lateral extentand being formed with a groove in its inner surface, one wall of saidgroove being located substantially in the plane of the lateral edge ofsaid one curved wall, a removable closure plate having one edgereceivable in said groove, and having its opposite edge held in contactwith said lateral edge, and spring means urged by said closure plateinto Contact with the adjacent surface of said saddle.

13. A holder for a curved saddle comprising a curved guide having anopen side through which a saddle may be received, one curved wall ofsaid guide being of a lateral extent substantially equal to thethickness of said saddle and the other being of greater lateral extentand being formed with a groove in its inner surface, one Wall of saidgroove being located substantially in the plane of the lateral edge ofsaid one curved Wall, a removable closure plate having one edgereceivable in said groove, and having its opposite edge held in contactwith said lateral edge, and spring means carried by said closure plateand bearing on the adjacent surface of said saddle.

14. A holder for a curved saddle comprising a curved guide having anopen side through which a saddle may be received, one curved wall ofsaid guide being of a lateral extent substantially equal to thethickness of said saddle and the other being of greater lateral extentand being formed with a groove in its inner surface, one Wall of saidgroove being located substantially in the plane of the lateral edge ofsaid one curved Wall, means cooperating with said lateral edge to form aslot, a removable closure plate having one edge receivable in saidgroove, and a tongue on the opposite edge of said plate receivable insaid slot.

15. In a device of the class described, a base including a rod ofcircular cross-section, a plurality of supports mounted on said rod andadjustable axially thereof, a saddle carried by each of said supports,bone-engaging means rigidly connected to each of said saddles, andtoothed means associated with at least one of said supports for securingthe same in any one of a plurality of adjusted positions about the axisof said rod.

16. In a device of the class described, a base including a rod ofcircular cross-section, a plurality of supports mounted on said rod andadjustable axially thereof, a saddle carried by each of said supports,bone-engaging means rigidly connected to each of said saddles, and meansassociated with at least one of said supports for mechanically shiftingthe same incrementally to any position of adjustment about the axis ofsaid rod and holding the same in any such adjusted position.

17. In a device of the class described, a base including a rod ofcircular cross-section and provided With a longitudinally extendingkerf, a plurality of supports mounted on said rod and adjustable axiallythereof, a saddle carried b-y each of said supports, bone-engaging meansrigidly connected to each of said saddles, at least one of said supportscomprising a tubular element mounted on said rod and provided at one endWith a Worm Wheel, a unit mounted on said rod and provided with ashiftable key projectible, at

will, into said kerf to prevent movement of said unit about the axis ofsaid rod, and a worm carried by said unit upon an axis perpendicular toa plane including the axis of said rod, said unit being associable withsaid one support to mesh said Worm With said Worm Wheel.

18. In a device of the class described, a base including a rod ofcircular cross-section and provided With a longitudinally extendingkerf, a plurality of supports mounted on said rod and adjustable axiallythereof, a saddle carried by each of said supports, bone-engaging meansrigidly connected to each of said saddles, at least one of said supportscomprising a tubular element mounted on said rod. and provided at oneend With a Worm Wheel, a unit mounted on said rod and provided With ashiftable key projectible, at Will,

, into said kerf'to prevent movement of said unit about the axis of saidrod, an axle carried by said unit upon an axis perpendicular to a planeincluding the axis of said rod and oscillable, at Will, about an axisparallel to the axis of said rod, a Worm journalled on said axle, saidunit being associable with said one support to mesh said Worm with saidlWorm Wheel, and means engageable by said axle to prevent oscillationthereof about said last-named axis.

ALBERT A. THOMAS.

